Definition
Medication overuse involves using self-purchased or physician-prescribed medications for too long, too much, or too frequently. The duration of therapy prescribed by a healthcare professional or by the professional and patient information is exceeded, the maximum single or daily dose is too high because of a dose increase, or the dosing interval is too short. Medication overuse is not the same as so-called medication abuse or misuse, because overuse often occurs unintentionally during the medically indicated treatment of a disease. In abuse, on the other hand, a drug is intentionally used for other purposes, such as intoxication or doping.
Examples
Typical examples are (selection): laxatives for the treatment of chronic constipation:
- Bisacodyl
- Sodium picosulfate
- Senna
Decongestant nasal sprays for decongesting the nasal mucosa:
- Oxymetazoline
- Xylometazoline
Antihistamines for sleep disorders:
- Diphenhydramine
- Doxylamine
Medicines containing alcohol or caffeine:
- Caffeine
- Ethanol
Benzodiazepines for the treatment of sleep disorders and anxiety disorders:
- Alprazolam
- Lorazepam
- Oxazepam
Short-acting beta2-sympathomimetics for bronchodilatation:
- Salbutamol
- Terbutaline
Opioids for the treatment of cough and pain:
- Codeine
- Hydromorphone
- Oxycodone
- Tramadol
Analgesic for headaches and other pains:
- Acetylsalicylic acid
- Ibuprofen
- Paracetamol
Topical glucocorticoids for eczema and other skin conditions:
- Betamethasone valerate
- Clobetasol propionate
- Mometasone furoate
Triptans for the treatment of a migraine:
- Eletriptan
- Sumatriptan
- Zolmitriptan
Z-drugs for the treatment of sleep disorders:
- Zolpidem
- Zopiclone
Causes
Medication overuse is often unintentional and not self-inflicted by patients. Rather, they get into a vicious cycle due to drug therapy, in which they must continue to use the drug to prevent withdrawal symptoms or the recurrence of symptoms. For example, too frequent use of painkillers for headaches can itself lead to a chronic headache, which in turn makes it necessary to continue taking the medication. However, if the medication is discontinued, the complaints improve. Patients have to keep getting the medicine they need, which can be inconvenient and costly. Deeper reasons include habituation during therapy, tolerance development, and the development of dependence and addiction. Medicines can also be consumed uncritically, unknowingly and without thinking. This is another reason why good counseling when dispensing medications and monitoring medication withdrawals are critical.
Diagnosis
It is important to note that not every frequent withdrawal of a medication constitutes overuse. For example, effervescent tablets containing acetaminophen and codeine (Co-Dafalgan) may be taken up to 8 times daily. With a package size of 16 effervescent tablets, one package will only last for two days at the maximum dose. Thus, up to a maximum of 15 packs may be needed per month. The dose and therapy duration information in the SmPC may be low and cautious for legal or regulatory reasons. In some circumstances, a higher dose may be possible or necessary from a scientific or medical perspective.
Complications
The consequences of drug overuse depend on the drug. In the worst cases, they are life-threatening. For example, pain relievers such as the NSAIDs can cause serious side effects such as bleeding in the gastrointestinal tract or kidney dysfunction. Paracetamol is toxic to the liver. Topical glucocorticoids thin the skin, causing streaks and pigmentation disorders. Benzodiazepines may promote falls and other accidents.
Possible measures and prevention
For treatment, the vicious cycle that has developed must be broken. This usually requires withdrawal. Treatment:
- Seek to talk to the person affected and offer help.Discuss the issue.
- Under medical supervision or inpatient, carry out a withdrawal. Due to withdrawal symptoms, not all medications can be abruptly discontinued.
- Reduce the dose.
- Agree that within a month only a defined amount is obtained.
- Taking under supervision.
- Seek better tolerated or more effective alternatives, change therapy.
- Substitution therapy.
- Psychological or psychiatric care, support / coaching by a professional.
Prevention:
